Excerpt

This is prospective, observational study of 350 patients from 36 centers, enrolled between June 1, 2002, and October 31, 2010. The primary objective of this study is to compare the safety and efficacy of surgical, stent, and balloon angioplasty (BA) treatment of native coarctation of the aorta acutely, at short-term and intermediate follow-up. The cohort group was divided into 3 treatment arms, 217 underwent stent placement, 61 underwent BA, and 72 underwent surgical repair of their native coarctation segment. All 3 intervention modalities showed significant improvement in the systolic blood pressure and in the upper to lower extremity systolic blood pressure gradient (ULG). The stent group was superior to BA in achieving lower gradient, with no significant differences observed between stent and surgery. No deaths occurred in any group. Both the surgical group and BA group had more complications than the stent group. Surgical patients had a longer mean length of hospital stay as compared with stent patients. Complications associated with BA patients were primarily related to aortic wall injury. On short-term follow-up (3 and 18 months), reobstruction was noted with equal frequency in all 3 treatment groups, with BA showing the greatest tendency toward developing reobstruction. It was also noticed that aortic wall injury was significantly greater in the BA group, primarily due to aneurysm formation. There were no significant differences in resting hypertension or mean ULG among the 3 groups. The study concludes that patients who underwent stent placements had significantly lower acute complications compared to surgery patients and BA patients. At short-term and intermediate follow-up, stent and surgical patients had a better outcomes compared to BA patients. Although, stent patients were more likely to require a planned reintervention, but with no differences observed among the 3 groups regarding the need for performing unplanned reinterventions. …